• Lead and scale a high-performing team responsible for operational execution of data mining and audit-support activities • Ensure operational outputs are accurate, consistent, and actionable • Build, manage, and deliver against annual and ongoing budgets • Monitor operational spend and ensure the organization meets financial targets • Collaborate closely with client-aligned stakeholders and internal cross-functional partners • Continuously improve operational processes and performance through strong metrics discipline

• Lead a team responsible for operational execution of data mining and claims review activities • Oversee day-to-day review operations supporting Medicaid RAC initiatives • Provide direct supervision, coaching, and performance management for a team • Ensure that review selections align with approved RAC scopes • Coordinate closely with analytics, data engineering, quality assurance, and reporting teams • Support budget adherence and operational forecasting for their team

• Own weekly, monthly, and quarterly forecasting processes • Drive forecast accuracy and visibility into bookings, backlog, revenue, and utilization • Develop predictive pipeline models including stage weighting, velocity, and win rates • Partner with Finance to align bookings forecasts with revenue recognition planning • Deliver executive dashboards and board-ready reporting • Own Salesforce CRM architecture, hygiene, reporting standards, and pipeline integrity • Define opportunity stage criteria and enforce sales methodology (e.g., MEDDPICC) • Standardize pipeline reviews, forecasting cadence, and reporting rhythms • Integrate CRM with PSA / ERP systems for services forecasting visibility • Drive automation across pipeline management and account planning • Design and administer sales compensation plans aligned to bookings and revenue realization • Model quota allocation and attainment scenarios • Manage SPIFF programs and incentive structures • Oversee partner-influenced crediting logic • Ensure data accuracy for commission reporting and auditability • Align co-sell motion with Salesforce AEs and RVPs • Track partner-sourced and partner-influenced pipeline • Support AppExchange / Industry Cloud reporting requirements • Manage MDF tracking and ROI reporting • Support partner tier advancement strategies such as Crest or Summit • Model sales capacity, ramp time, and territory design • Analyze vertical performance across key Salesforce solutions (e.g., Financial Services Cloud, Data Cloud) • Align resource planning with bookings targets • Identify whitespace opportunities across accounts and industries • Lead QBR preparation and territory performance reviews • Standardize pricing approval workflows • Improve proposal-to-close cycle time • Establish scalable operating cadence across regions

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Reporting to the Director of Member and Provider Service, the Operations Manager is responsible for providing operational oversight including compliance, program development, evaluation, and performance monitoring. This role assumes management of and accountability for day-to-day service operations and is the subject matter expert for service operations. Key Functions/Responsibilities - Work with Director on development and execution of service strategy - Identify trends, risks, and opportunities to set strategic direction - Identify key strategic considerations for efficient workflows, best practices, and service models - Collaborate with functional leaders to identify initiatives that improve service to members and providers, create efficiencies, and support product growth and health improvement initiatives - Synthesize information into impactful materials and presentations to facilitate recommendations to the COO and Executive Teams - Lead business planning efforts for Member and Provider Service - Effectively work in a matrix environment to accomplish work across multiple teams in the health plan and health system - Lead meetings, put content into framework, organize people, and drive implementation - Understand and visualize data, make data-driven decisions, and create reporting - Develop, implement, and enhance processes to drive overall performance of service initiatives - Lead implementation projects assigned in accordance with priority - Develop methodologies and infrastructure to measure the impact of executed initiatives - Represent Member and Provider Service as the subject matter expert on corporate initiatives - Make recommendations related to member and provider service impact and operations - Lead implementation of any resulting work, internal project teams, coordinates communication, training, documentation, and reporting - Identify, communicate, and escalate issues to the Director of Member and Provider Service on a timely basis - Independently problem-solve programmatic issues and implement appropriate solutions - Responsible for ensuring compliance with contractual and regulatory requirements - Effectively document the components of the programs necessary for compliance with regulatory standards and submission to external agencies - Represent Member and Provider Service in meetings with external auditors and regulators - Coordinate and track the completion of regulatory training for all Member and Provider Service staff and responsible vendors - Develop and oversee the production of regulatory reports and standard KPI reports - Implement operational enhancements in partnership with Service leadership - Accountable for timely notification to the Director and Service Manager if operational performance falls below expectations - Collaborate with Service leadership, CX Analyst, and vendors to identify opportunities for improvement Supervision Exercised No direct reports; manages projects in a matrixed environment. Supervision Received Weekly supervision with Director of Member and Provider Service. Qualifications - Bachelor’s degree - Project management certification (preferred) - Masters degree in Business Administration or related field (preferred) - 5+ years of healthcare/managed care experience - 5+ years of service center experience or other applicable work experience - Project management experience preferred - Pre-employment background check Competencies, Skills, and Attributes - Strategic thinker - Exceptional written and oral communication skills - Excellent organizational skills and attention to detail - Ability to interact with all levels of the organization, as well as external stakeholders - Superior meeting facilitation skills and experience in leading cross-functional teams - Demonstrated ability to work independently and manage multiple complex projects simultaneously - Proactive, motivated, and a collaborative team player - Demonstrated ability to adapt quickly to changing priorities - Ability to analyze, compile, format, and present data to a variety of stakeholders - Strong critical thinking, analytical, and problem-solving skills - Proficiency with MS tools including Word, Excel, PowerPoint, Visio, and MS Project - Demonstrated ability of managing competing priorities as well as stakeholders with differing objectives/perspectives - Effective at forming alliances with other departments to develop partnerships and commitment toward completing the project - Able to negotiate enterprise solutions with other departments that work interdepartmentally Working Conditions and Physical Effort - Work is normally performed in a typical interior/office work environment - Able to perform some work from a remote environment - Fast-paced environment - No or very limited physical effort is required - No or very limited exposure to physical risk - Regular and reliable attendance is an essential function of the position Compensation Range $86,500 - $125,500. This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. Benefits - Generous total compensation that includes benefits (medical, dental, vision, pharmacy) - Merit increases - Flexible Spending Accounts - 403(b) savings matches - Paid time off - Career advancement opportunities - Resources to support employee and family wellbeing